August 26, 2010 - It is, sadly, very clear nowadays that Israelis blatantly ignore, deny and trample on the anti-smoking legislation, and the authorities simply ignore it – to the future cost of their citizens’ health. In a study by public health expert Dr. Leah Rosen of Tel Aviv University showed that owners of Tel Aviv pubs consistently fail to enforce laws, and inform one another that municipal inspectors are on the prowl for violators. Similar attitudes were prevalent in Britain until, in the 1990s, the government realized the real costs of treating smokers and non-smoking adults and children.

In the 1990s, the estimated cost to American society of smoking was $52 billion in health expenses or time lost from work – about $221 per person each year, according to federal officials. The current cost of passive smoking in the UK to children’s health alone was estimated at £23.3 million per year.

The British government in 2002 estimated that the net benefits (after calculating loss of revenue and other costs as well as benefits) of just making all workplaces smoke free would be between £2.3 and £2.7 billion per year. This is equivalent to treating 1.3-1.5 million hospital waiting list patients. In Scotland, the net benefit of making all public places smoke free was calculated at around £124 million per year. Other, similar, figures worldwide convinced politicians that preventing passive smoking would be of significant benefit to society.Health promotion then kicked in successfully, reinforced by bans on tobacco advertising, an increase in tax on cigarettes, presentation of the nonsmoking message on popular television, and various social marketing strategies. In addition, free stop-smoking clinics were provided along with subsidized nicotine treatments such as anti-craving drugs, nicotine patches, gum and inhalers. Not only the health of smokers was considered, but also the risks of passive smoking.

According to a May study by the Health Ministry, 22.8 percent of the adult population smokes. The study found 31.3% of men smoke, while for women the figure is 14.8%. A study of eighth-grade students found that 5% smoke occasionally. Jewish children whose parents smoke were 2.8 times more likely to smoke themselves. Arab children whose parents smoke were 5.8 times more likely to do so. According to a 2009 report in the European Journal of Public Health, 8,664 deaths in Israel were attributable to smoking in 2003. The number attributed to passive smoking is unclear.

GREATEST challenge to tackling smoking is in attitudes. Smokers often have a “live now, pay later” approach. I have heard a smoker say things like: “So what? I could be run over by a bus tomorrow, so I might as well enjoy my cigarette today.” This lasts until they or a relative’s health becomes severely impaired. I remember being put off smoking for life when my grandmother, then 61, had to have the iliac arteries in her legs replaced due to secondary damage from smoking.

The other common argument presented by smokers is “it’s my right to smoke if I want.”They conveniently forget the effect of their smoke on others and the reality of smoking being a purely selfish act.

The calculation of the personal cost of smoking and the benefits of stopping helped many give up.

A key approach to tackling smoking and passive smoking in Israel will be social marketing. This involves systematically applying the principles of marketing alongside other concepts and techniques to achieve changes in behavior. Commercial marketing is different in that its aims are primarily financial, measured in terms of profits or shareholder value. Social marketing aims specifically to achieve improvement in the lives of people. It works by focusing on specific groups in context and delivering messages to help create lasting change.